Poly neuropathy in pictures
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This document provides an overview of neuropathies including: 1. It discusses the anatomy of the central and peripheral nervous systems and describes the components and functions of nerves. 2. Several types of neuropathies are defined including mononeuropathy, mononeuritis multiplex, radiculopathy, and polyneuropathy. Common causes, clinical presentations, and diagnostic approaches are described for various neuropathies. 3. Specific neuropathies like Guillain-Barré syndrome, chronic inflammatory demyelinating polyneuropathy, Charcot-Marie-Tooth disease, and carpal tunnel syndrome are explained in more detail.
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Poly neuropathy in pictures
- 4. ANATOMY CNS PNS UMNL= lesion above LMNL= lesion below
- 5. PNS CONSISTS OF? 1. Anterior horn cell 2. Motor neurons 3. Ventral root 4. Dorsal root ganglia 1. Dorsal root 2. Plexus 3. Peripheral nerve 4. Neuromuscular junction 5. Muscles
- 7. WHAT IS THE MAIN FUNCTION OF THE NERVE??
- 8. WHAT IS THE NERVE FUNCTION? Conduction of impulse????????????
- 10. NERVE FIBERS
- 11. NERVES DIAMETER
- 12. PATHOGENIC MECHANISMS OF NERVE DAMAGE A. Wallerian degeneration B. Axonal degeneration C. Segmental degeneration
- 14. AXONAL DEGENERATIONDying back phenomenon (Typically in metabolic Neuropathies)
- 15. SEGMENTAL DEGENERATIO N (DEMYELINATIO N) Ch. by focal degeneration of the myelin with sparing of the axons and bounded on each end by preserved myelin
- 16. CLINICAL PICTURE Sensory, Motor & Autonomic
- 17. SENSORY SYMPTOMS
- 18. MOTOR SYMPTOMS
- 19. MOTOR SYMPTOMS
- 21. AUTONOMIC NEUROPATHY Hypertension (+ve) Postural hypotension, Sweating, Urine retention, Impotence, Vascular color changing, GIT complains.
- 22. DEFINITIONS • Mononeuropathy • Mononeuritis multiplex • Radiculopathy • Plexopathy • Cranial neuropathy • Polyneuropathy (peripheral neuropathy)
- 24. CLASSIFICATION • By type of fiber involved • Pure sensory • Pure motor • Mixed sensory & motor • Autonomic • By pathology • Axonal • Demyelinating • Mixed • By pathology • Acute (days-1m) • Subacute (1-2m) • Chronic (>2m) • Monophonic, Progressive, Relapsing
- 25. Predominantly Sensory • DM & Uraemia • thiamine deficiency • leprosy • HSN & malignancy • Amyloidosis • Alcoholic Predominantly Motor • GBS & CIDP • lead • porphyria • diphtheria • botulism • Charcot-Marie-Tooth • Paraneoplastic syndrome
- 26. DEMYELINATING NEUROPATHIES Acute • Guillain Barre syndrome (GBS) Chronic • CIDP • paraproteinemia related • amiodarone toxicity • Refsum’s disease • Charcot-Marie-Tooth (CMT) • metachromatic leucodystrophy
- 27. CHRONIC AXONAL NEUROPATHY 1. Drug and toxin: Alcohol, vincristine, phenytoin, organophosphate, statins, metronidazole, dapsone 2. Infection: Leprosy, HIV, Borreliosis 3. Connective tissue: Sjogren's syndrome, SLE, rheumatoid arthritis 4. Metabolic: Diabetes, chronic renal failure 5. Paraneoplastic: Carcinoma of the lung and ovary. 6. Inherited: CMT 2 and CMT X 7. Vitamin deficiency: B12, Folic acid, Vitamin E 8. Endocrine: Hypothyroidism 9. Paraproteinemia: Myxedema, Benign monoclonal gammopathy
- 28. FOCAL MULTI FOCAL NEUROPATHIES1. Entrapment neuropathy: Carpal tunnel syndrome, ulnar nerve at the elbow, common peroneal at the fibular head 2. Endocrinal: diabetes mellitus, myxedema, acromegaly 3. Amyloidosis 4. Hereditary neuropathy susceptible to pressure palsy 5. Vasculitis 6. Multifocal motor neuropathy with conduction block
- 30. INVESTIGATIO NS 1. Nerve Conduction study 2. Nerve biopsy, 3. Lab. Tests 4. Genetic testing, 5. CSF
- 33. Etiology- C/P- investigations-DD - complication- Management
- 34. CIDP Immune mediated demyelinating polyneuropathy Presents with LL weakness and sensory changes, and less commonly, CN palsy, One of three clinical syndromes: 1. Monophasic illness with symptoms lasting > 2 months 2. Slow progressive course 3. Relapsing/remitting course NCS consistent with demyelination LP with increased protein Treatment:
- 35. CHARCOT-MARIE-TOOTH DISEASE AD, duplication in the peripheral myelin protein 22 (PMP22) gene on 17p11.2-12 Progressive distal polyneuropathy Begins in intrinsic foot muscles, and then progresses to include proximal weakness, as well as to involve hand muscles Hammer toes, pronounced arch, thin tapered appearance of legs Onset in first 2 decades First symptoms include: Difficulty with heel walking Pes cavus Calf atrophy Decreased reflexes Progresses to include Worsening of above Impairment of vibration and proprioception Touch, pain and temperature sensation less commonly involved Diagnosis: EMG/NCS Genetic testing
- 37. ANY QUESTIONS
- 39. MYASTHENIA
- 40. MYASTHENIA
- 41. ANY QUESTIONS?
Notes de l'éditeur
- Myelin sheath is the most susceptible to damage, It can break down as a result of damage to Schwann cell, myelin itself or disease affecting axon.
- Mononeuropathy Pattern of weakness and sensory loss conforms to the distribution of a single nerve Carpal tunnel syndrome Peroneal palsy at the fibular head Mononeuritis multiplex Multiple nerves affected in a random pattern Acute onset, frequently painful Diabetes mellitus, vasculitis Radiculopathy – nerve root Plexopathy – brachial or lumbosacral plexus Cranial neuropathy – Bell’s Palsy, 3rd nerve palsy Polyneuropathy (peripheral neuropathy) Distal, symmetric
- Monophasic==> GBS Progressive ==>DM, CIDP Relapsing==> recurrent GBS
- Leprosy, Neurofibromatosis, Refsum's disease, Amyloidosis, Roussy Levy syndrome. CMT1,3
- Indication of nerve biopsy ( suspicion of) Amyloidosis Vasculitis Leprosy Sarcoidosis Cidp